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Jose A. Cruz, LCSW, MBA, CTTS

Division Addiction Psychiatry

Robert Wood Johnson Medical School

Tobacco Marketing Marketing strategies used to target

vulnerable populations

Acknowledgements

SAMHSA's Partnerships for Success Program

Rutgers University, Division of Addiction Psychiatry, has been approved by the New Jersey Department of Health as a provider of

New Jersey Public Health Continuing Education Contact Hours (CEs).

Participants who successfully complete this educational program will be awarded (1) One NJ Public Health Continuing Education

Contact Hours (CEs).

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Tobacco= #1 Cause of Death in US

30% OF ALL CANCER DEATHS

National Prevention Strategy (17 Federal Departments)

• Tobacco Free Living

• Preventing Drug Abuse and Excessive

Alcohol Use

• Healthy Eating

• Active Living

• Injury and Violence Free Living

• Reproductive and Sexual Health

• Mental and Emotional Well-being

Tobacco Use= Disparity Groups

37.8

45.1

63.6

21.3

34.5

0

10

20

30

40

50

60

70

Anxiety Disorder

Affective Disorder

Substance Use Disorder

No Mental Disorder

Medicaid

Current Disorder (<12 mo)

NCS-R 2001-2003; Diagnoses using CIDI

Lawrence et al, BMC Public Health 2009, 9:285

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Past Month Tobacco Use among Youths Aged 12 to 17: 2002-2013

National Survey on Drug Use and Health

Electronic cigarette

1.5

2.8

4.5

NJ Smoking Rates

NJ Smoking Prevalence ~ 16%

Higher than State Tobacco

Average

Salem 25%

Cumberland 25%

Atlantic 22%

Cape May 21%

Camden 19%

Gloucester 19%

Warren 19%

Sussex 18%

Somerset 9%

Middlesex 12%

Hunterdon 13%

Mercer 13%

Highest per Capita Income

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$0

$2

$4

$6

$8

$10

$12

$14

$16

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

POS Total

All Other

Price Discounts

Ann

ual E

xpen

ditu

res

($

billi

ons)

MSA

Note: POS includes POS advertising, price discounts, promotional allowances and retail value added. After 2001, POS excludes

promotional allowances to wholesalers and others, and price discounts are included in POS Total and identified separately.

Source: Federal Trade Commission, 2011.

TOBACCO INDUSTRY MARKETING EXPENDITURES

FSPTCA

Ribisl 2011

TOBACCO INDUSTRY MARKETING EXPENDITURES

• Advertising and promotional expenditures increased from $8.37 billion to

$9.17 billion

• The largest single category of expenditures in 2012 was $9.6 billion

marketing cigarettes and smokeless tobacco. That is $26 million a day or

$1 million every hour.

• According to the 2012 Federal Trade Commission Cigarette Report, the

largest expenditures was in price discounts paid to cigarette retailers or

wholesalers in order to reduce the price of cigarettes to consumers, which

accounted for $7.802 billion (85.1 percent of total advertising and

promotional expenditures).

• About 13.2 billion cigars, including 12.5 billion large cigars and

cigarillos and 0.7 billion little cigars, were sold in the United States

in 2013.

https://www.ftc.gov/system/files/documents/reports/federal-trade-commission-cigarette-report-2012/150327-

2012cigaretterpt.pdf

TOBACCO INDUSTRY MARKETING EXPENDITURES

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• Smoking-related illness in the United States costs more than $300 billion each

year, including: Nearly $170 billion for direct medical care for adults

• More than $156 billion in lost productivity, including $5.6 billion in lost productivity

due to secondhand smoke exposure

• The FDA’s Real Cost Campaign:

The United States is the fourth largest tobacco-producing country in the

world, following China (which produced 3.2 million tons in 2012), India, and

Brazil.

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/marketing/

2014 Surgeon General's Report, Table 12.4, page 660

The Marketing Mix - Building a brand

• Product

• Price

“In the marketing cycle of cigarettes, without a

consumer-related identity, there is no brand loyalty and

without brand loyalty there is no market.”

PAPERS FROM THE 690000 A.A.A.A. REGION CONVENTIONS HOW AN AGENCY BUILDS A BRAND -- THE

VIRGINIA SLIMS STORY. Retrieved from http://legacy.library.ucsf.edu/tid/efc64e00

• Promotion

• Place

2014: Marlboro is the most popular cigarette brand in U.S.

Market Shares for Leading Cigarette Brands

Brand Market %

Marlboro 40.80%

Newport 12.40%

Camel 7.90%

Pall Mall Box 7.80%

Pyramid 2.00%

Note: Market share—or market percentage—is defined as the percentage of total sales in the United States.

Maxwell JC. The Maxwell Report: Year End & Fourth Quarter 2014 Cigarette Industry. Richmond (VA): John C. Maxwell, Jr., 2015

According to American parent company Altria

(MO), Marlboro has been the largest cigarette

brand in the U.S for the last 35 years. It has 44% market share in the U.S., making it larger

than the next 10 cigarette brands combined.-

CNN Money, retrieved from

http://money.cnn.com/2015/05/27/news/compan

ies/marlboro-brand-tobacco-cigarettes/

Altria:

Basic Benson & Hedges

Cambridge Chesterfield Commander Dave's

English Ovals Lark

L&M Marlboro

Merit Parliament

Players Saratoga Virginia Slims

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http://www.wsj.com/articles/reynolds-american-to-buy-lorillard-for-27-4-billion-1405422823

History of Tobacco Marketing

http://www.trinketsandtrash.org/

History of Tobacco Marketing

-http://www.trinketsandtrash.org/

“More doctors smoke Camels than any other cigarette”

“More Doctors” campaign

“Well aware of these concerns—and their impact on cigarette sales—the tobacco

companies devised advertising and marketing strategies to (1) reassure the public of the

competitive health advantages of their brands, (2) recruit physicians as crucial allies in the

ongoing process of marketing tobacco, and (3) maintain the salience of individual clinical

judgments about the health effects of smoking in the face of categorical scientific

findings.”

Source. Magazine of Wall Street .

July 26, 1930.

Source. Ohio State Journal of Medicine.

July 1949;45:670. Source. Saturday Evening

Post. October 16, 1937.

Gardner, M. N., & Brandt, A. M. (2006). “The Doctors’ Choice Is America’s Choice”: The Physician in US Cigarette

Advertisements, 1930–1953. American Journal of Public Health, 96(2), 222–232. doi:10.2105/AJPH.2005.066654

-http://tobacco.stanford.edu/tobacco_main/index.php

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Marketing strategies

focused on women

Women, Tobacco and Cancer: An Agenda for the 21st

Century. U.S. Department of Health and Human Services,

2004

Wilcox and Company, 1881 Pioneer Tobacco, 1900

http://tobacco.stanford.edu/tobacco_main/main.php

http://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_women_smoking_508.pdf

http://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_women_smoking_508.pdf

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http://legacy.library.ucsf.edu/tid/aze37b00

Research Collection (1969)

pg. 57

Marketing strategies focused on children

SURGEON GENERAl 'S WA RNING, Smoking Jh • p ............ . ,.,.. ,..... .....\1 " " '• " " ; , . , 6, 1

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http://legacy.library.ucsf.edu/tid/eyn18c00 RJ Reynolds (1984 est.)

http://legacy.library.ucsf.edu/tid/pvt37b00

Tobacco Institute (1989)

Tobacco in New Jersey’s stores

New Jersey Tobacco Point of Sale Project, 2014. A report that focused on retailers near schools in nine NJ communities

– Multiple factors affected the diversity of advertisments, promotions and

products

– Most stores had exterior advertisments

– There are still a noticeable number of flavored and menthol cigs ads

– Although new, e-cig ads rivaled the number of cig and smokeless tobacco ads

– Most retailers sold flavored cigars for less than a dollar

– The selling of snus and electronic cigarettes/devices varied

http://www.nj.gov/health/ctcp/documents/tobacco_marketing.pdf

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Chesterfield, 1951 vs Winston, 1972

Chesterfield, 1962 vs Newport, 2011 Lucky Strike, 1937 vs Virginia Slims, 1975

Lucky Strike, 1932 vs Kool, 2000

RJR’s Natural American Spirit and Grizzly smokeless tobacco

2010: Attorneys General from

33 states and the District of

Columbia, led by California, required that the Santa Fe

Natural Tobacco Company

(division of Reynold America)

add a disclaimer stating,

"Organic tobacco does NOT mean a safer cigarette”

Reaching diverse populations- people of color

Each year, approximately 45,000

African Americans die from a

preventable smoking-related disease. - CDC, 2003

Lung cancer is the leading cause of cancer

deaths among Latinos living in the United

States. - American Cancer Society, 2008

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75% of African Americans prefer

menthol cigarettes

Influences smoking behavior,

nicotine levels, ? metabolism

Cools airway → ? Changing puff

behavior

Higher menthol in those with

mental illness

JM et al., Nicotine & Tobacco Research 2007

Menthol Cigarettes: Targeting at its worst

Lower quit rates among African American &

Latino menthol cigarette smokers

Reaching diverse and vulnerable populations: LGBTQQI

PROJECT SCUM:

(Sub-Culture Urban Marketing)

• Alternative Life Styles

• International Influence

• Rebellious, Generation X

• Street People

RJ Reynolds 1995

http://legacy.library.ucsf.edu/tid/mum76d00

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Campaign for Tobacco Free Kids Report, June 2014

A Sophisticated Product…

• Prior to 2010, “Light”, “Ultra Light” were allowed. Criteria was that it had to deliver 15mg of tar

when “measured by an automated smoking machine.”-CDC

• “Defendants have designed their cigarettes to precisely control nicotine delivery levels and

provide doses of nicotine sufficient to create and sustain addiction” -U.S. v. Philip Morris, USA, Inc., 449 F.

Supp. 2d (D.D.C. 2006) at 309

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http://countertobacco.org/

Young People Need to Know

There are

more and

more new

tobacco

products

being

introduced

on the

market.

However,

NO tobacco

product is

safe!

Emerging and Unique Tobacco Products

Stuff Magazine, Nov. 2010

Playboy, 2009 http://www.wikihow.com/Dip-Smokeless-Tobacco

Original Sources:

Car and Driver: May 2013

Field and Stream: April 2013

Outdoor Life: April 2013

Popular Mechanics: May 2013 Rolling Stone: April 11, 2013

http://www.trinketsandtrash.org

/detail.php?artifactid=7689&page

=3

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Men's Journal - October 2011

“E-Cigs Lingo

Vaping. Cartomizers. Smoke Juice.”

Events:

Marie Claire, Jan 2013

Men's Journal, June 2013

Esquire - January 2012

Men's Journal - March 2012, May 2012

Flavored Products

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“The evidence is sufficient to infer that the relative risk of dying from cigarette smoking has increased over the last 50 years in men and women in the United States.”

— 2014 Surgeon General’s Report

1998 Master Settlement Agreement:

• States will receive over $206 billion over 25 years. NJ > $247 million

• Addresses marketing strategies, i.e. Billboards, cartoons, merchandise and advertisement for youths

Family Smoking Prevention and Tobacco Control Act: granted FDA authority to regulate manufacturing, marketing and sale of tobacco products

Post MSA:

• More expenditure on direct and comprehensive strategies to reach subgroups

• Focus on younger adults

• Preferences, attitudes and lifestyle

• Incentives: 449 days or 8,980 cigarettes gets you a Outdoor charcoal smoker

Tobacco Control

Tobacco Control

• Prevention

• Treatment

• Policy/ New Jersey Smokefree Air Act (NJ SFAA) 2006

• Surveillance and Research

• Price, Taxes and Access

• Litigation against Tobacco Industry

• http://njtobaccofree.org/

Some things to look for in your community stores

• What type of retailers are there in your community?

• What other establishments are located nearby, i.e. schools,

churches, playgrounds or other places where youth gather?

• How prominent is advertising for tobacco, electronic cigarettes or

hookah products outside and inside the store? What percentage of

the windows or the front area is covered by signs or advertisement?

• Specifically, what products are emphasized more or less?

• Is there any indication, i.e. a visible sign, that the retailer or store

employees verify the age of customers who purchase tobacco?

• How could the “Look, See, Check ID” brochure help engage retailers

in addressing tobacco use among youth?

CADCA: Environmental Scan Example, adapted from the Getting to Outcomes Manual (Rand Corporation, 2007)

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Conclusions

• Tobacco is a drug that affects diverse groups and subgroups of populations

differently

• The tobacco industry continues to differentiate its products and attempts to

build brand loyalty

• It is important to expose how tobacco companies target vulnerable

populations and increase the burden they carry in dealing with this deadly

addiction

• Tobacco prevention is an important part of substance use prevention

Jill M Williams, M.D.

Professor of Psychiatry and Director of the Division of Addiction Psychiatry

Rutgers University-Robert Wood Johnson Medical School

williajm@rwjms.rutgers.edu

732-235-4341

Jose A. Cruz, LCSW, MBA

Addictions Consultant / Mental Health Clinician

Rutgers University, RWJMS, Division of Addiction Psychiatry

cruzj3@rwjms.rutgers.edu

732-235-4497